Malleable clip applier and method

ABSTRACT

An endoscopic clip applier for the temporary as well as permanent occlusion of vessels and the clipping of other tissues. The clip applier includes an elongated outer body having a proximal end attached to an actuating mechanism and a distal end. An elongated inner member is slidably positioned within the outer body and has a proximal end coupled to the actuating mechanism and a distal end coupled to a pair of generally opposing jaws. Movement of the inner member relative to the outer body pivots the jaws open and closed. The jaws are configured for receiving and supporting a malleable surgical clip which is insertable within an internal retention groove within each jaw. Each groove has an undercut portion at its distal end which is configured to mate with an outwardly tapering portion at the distal end of each clip. When forced distally in the grooves, the distal ends of the clip are moved into the undercut portion and the clip retained within the groove. The clip may then be compressed and opened any number of times to facilitate its insertion, placement and removal.

RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.60/015,578, filed Apr. 18, 1996.

FIELD OF THE INVENTION

This invention relates generally to surgical clip appliers and surgicalclips and, more particularly, to and endoscopic surgical clip applierfor use with malleable surgical clips.

BACKGROUND OF THE INVENTION

Endoscopic surgical techniques, including laparoscopic and arthroscopictechniques, are gaining wide acceptance and are being increasingly used.There are many benefits associated with these minimally invasivetechniques, including reduced patient trauma, reduced risk ofpost-operative infection and a reduced recovery time.

Various types of surgical instruments have been developed for use withthese endoscopic surgical techniques and procedures, including clipappliers for the occlusion and ligation of vessels or other conduits andtissues. Conventional clip appliers, as currently used in theseendoscopic procedures, typically consist of a frame connected to anactuating mechanism. A pair of clip compressing devices or jaws aresupported at the distal end of the frame. The jaws typically consist ofa pair of opposing jaw members which are movable with respect to eachother. Each of the jaw members may include a slot or other means forretaining each of the legs of a surgical ligating clip. The outersurfaces of the jaw members may include cam surfaces which allow formovement by the actuating mechanism. In this configuration, the jaws areactuated by sliding an outer frame member over the cam surfaces, therebyforcing the jaw members towards each other. The ligating clips areinsertable between the jaw members and within the inner grooves.

A conventional ligating clip has a pair of outwardly extending legsconnected at an apex. The legs typically extend in a V-shaped orU-shaped manner from the apex and then change directions angularly at aknee portion to extend outward from the apex.

There are several deficiencies associated with the conventionalendoscopic ligating clip appliers as described and as currently used.For instance, when using a ligating clip applier in an endoscopicprocedure, the instrument is initially inserted through a cannula of anendoscopic trocar so that the clip may be positioned on the vessel orother tissue. The size of the vessel or tissue to be ligated is limitedby the size of the clip being applied. In general, a larger vessel ortissue requires a larger clip. However, the size of the ligating clip islimited, in part, by the internal diameter of the trocar through whichthe ligating clip applier must be inserted.

In one version of the conventional ligating clip applier as previouslydescribed, the clip is retained within the jaw members. The jaw membersextend outwardly from the frame but the opening between the jaws remainsin substantial alignment with the longitudinal axis of the clip applier.A clip is inserted into the open jaws or into the hollow frame which isthen passed through a trocar and manipulated within the patient until itis positioned around the tissue to be clipped. In this configuration,the open jaw members supporting the outwardly extending legs of theclip, or alternatively, the hollow frame member holding the open clipmust define a diameter smaller than the internal diameter of thecannula. Otherwise, the clip applier can not pass through the trocarcannula.

In an alternative clip applier configuration, where the jaws move in anorientation perpendicular to the longitudinal axis, the size of the clipis also limited by the inner diameter of the cannula. In thisconfiguration, the length of the clip from the end of the legs to theapex (length) must be smaller than the inner diameter of the cannula.Therefore, the overall width and length of the clip are limiting factorswith regard to insertion through a trocar.

Another deficiency associated with conventional ligating clip appliersis the difficulty the endoscopic surgeon encounters when attempting tocontrol the position of the clip during application. Often times, a clipis either improperly applied or applied to the wrong location. In theseinstances, the surgeon is required to apply another clip to theappropriate location. In addition, the surgeon must now remove or leavein the patient, at least two clips. Thus, there is a need for anendoscopic clip applier and associated ligating clip which may berepositioned during surgery and is also easily removed from the appliedtissue.

Yet another deficiency associated with conventional ligating clipappliers and ligating clips is that the legs of the clip typicallyprotrude inwardly from the inner jaw surfaces of the clip applier. Thismakes manipulation of the clip applier and clip within the patient moredifficult. In part, this is due to the configuration of the jaws of aconventional ligating clip applier, wherein the jaw members do notwholly retain the legs of the clip within their inner surfaces. In otherclip applier configurations, the deficiency is due in part to theconfiguration of the clip which has legs protruding outwardly from thedistal ends of the jaws.

What is needed in this field, is an endoscopic clip applier andassociated clip which overcomes these deficiencies and which is easy touse by the endoscopic surgeon and is economical to manufacture.

SUMMARY OF THE INVENTION

The present invention satisfies the need for clip applier for ligatingand occluding vessels and other tissues by providing an endoscopic clipapplier that is capable of inserting a surgical clip through a cannulawhile being maintained in a minimum diameter configuration. By insertingthe surgical clip into the opposing jaw members of the clip applier andthen closing the jaws such that the width (diameter) of the clip isminimized, a clip of almost any size may be passed through aconventional cannula. This allows the ligating and occluding of almostany size vessel or other tissue while using conventional endoscopictechniques. For purposes of this disclosure, endoscopic is defined toinclude laparoscopic, arthroscopic as well as any other surgicaltechniques related to the use of a trocar or small entry incision.

The present invention also satisfies the need for a clip applier andassociated surgical clip that is easy to manipulate within a patient andminimizes contact and damage to surrounding tissues. This isaccomplished by fully retaining the clip within the jaw members suchthat there are little or no protruding portions. In addition, the jawmembers of the present endoscopic clip applier protrude beyond thesurgical clip, providing a smooth continuous surface for ease ofmanipulation within a patient.

The present invention also satisfies the need for a clip applier foroccluding and ligating vessels and other tissues which is capable ofboth repositioning and removing a previously applied surgical clip. Thisis accomplished by providing a retention groove having an undercutportion within each jaw member. In operation, the jaw members are closedaround the clip which is then forced or otherwise moved forwardly suchthat the distal portion of each clip leg is retained within the undercutportion of each retention groove. The clip is thus retained within thejaw members whether the clip is opened or compressed closed. Byproviding a clip made from a malleable material, the clip may be openedand closed, repositioned, reused or removed a plurality of times.

The present invention is generally directed to an improved endoscopicclip applier for applying a surgical clip having outwardly extendinglegs to occlude or otherwise ligate a vessel or other tissue. Broadlyspeaking, the clip applier of the present invention includes anelongated outer body which defines a longitudinal axis between aproximal end and a distal end. An operating assembly is supported at thedistal end.

The operating assembly includes a pair of generally opposing jaw memberswhich extend outwardly from the elongated body. Each jaw member has aretention groove which extends generally longitudinally along an innersurface and terminates into an undercut portion. The groove and undercutportion are configured for releasably retaining the surgical clip withinthe opposing inner surfaces of the jaw members. An actuating mechanismis attached to the proximal end of the elongated outer body. Actuationof this mechanism moves the coupled jaw members between an open positionand a closed position.

In the closed position, the jaw members contact each other across theiropposing inner surfaces and generally along the longitudinal axis of theclip applier. With this configuration, a surgical clip of most any sizemay be utilized and is generally only limited by the longitudinal lengthof the jaw members.

In another broad aspect of the present invention, each of the jawmembers includes a generally longitudinal retention groove or groovewhich is sufficiently long and sufficiently deep such that a substantialportion of the clip is retained flush relative to the inner surface ofthe jaw member. In this way, the clip may be retained within the jawmembers without protruding from the jaw's inner surface. Thisconfiguration allows the jaw members to fully close along their innersurfaces as well as providing a smooth and continuous inner surface whenthe jaws are open.

In yet another broad aspect of the present invention, the surgical clipis made from a malleable material such that the clip may be insertedinto the endoscopic clip applier and closed and opened a plurality oftimes. In this way, a clip may be inserted into the clip applier,applied to a vessel or other tissue within the patient, repositioned aplurality of times and later removed. The clip is a generally U-shapedor V-shaped clip which has a pair of outwardly extending and generallyopposed legs. An intermediate portion connects the legs at theirproximal ends to form an apex.

In yet another broad aspect of the present invention, the undercutportion of each jaw member is sized and configured to allow the distalends of an associated surgical clip to fit inside or underneath. In thisway, each leg of the clip is positively retained within each jaw member.More specifically, each undercut portion defines an inwardly taperingportion or overhang at the distal end of each groove. In a similar andcompatible fashion, the distal end of each clip terminates in anoutwardly tapering portion or tab which fits against the inwardlytapering undercut portion of each jaw member. Thus when the clip ispushed or otherwise moved forwardly within the grooves, the outwardlytapering portion of each leg fits within the inwardly tapering portionof the undercut portion and is thus physically retained within the jawmembers.

In another embodiment of the present invention, the endoscopic clipapplier includes a hollow elongated outer body which has a proximal endconnected to an actuating mechanism and a distal end. An elongated innermember is also attached to the actuating mechanism at its proximal endand extends distally in a coaxial fashion with the elongated outer body.This inner member is movable relative to the outer body by operation ofthe actuating mechanism. An operating assembly is coupled to the distalend of the inner member. The operating assembly includes a pair ofpivotally opposing jaw members as previously described.

A push member or retention shaft is also coupled to the actuatingmechanism. The push member is configured for contacting and applying aforce against a proximal end (apex) of the clip such that the clip ismoved forwardly or distally within the grooves. In this fashion, thedistally tapered portion of each leg is forced into the undercut portionof each jaw member. The actuating mechanism is configured to remotelymove at least one of the jaw members between a closed position and anopen position.

The actuating mechanism includes a main body which is connected to theproximal end of the outer body and an actuating handle which is coupledto the main body and connected to the proximal end of the inner member.In this way, movement of the handle in relation to the main body forcesthe jaw members to move distally and proximally relative to the fixedouter body. A cammed surface or taper on the outer surface of each jawmember in contact with the distal end of the outer body causes the jawsto move relative to each other as the inner member and outer body aremoved. A biasing spring is included for forcing the handle in onedirection with respect to the main body such that the jaw members arenormally maintained in the closed position. A second handle or actuatingmechanism is coupled to the main body for actuating the push member. Asecond biasing spring is coupled to the actuating mechanism for forciblymaintaining the push member against the clip.

A method of applying a surgical clip to a vessel or other tissue in apatient according to the principals of the present invention includesthe steps of placing a malleable surgical clip which has a pair ofoutwardly extending legs within the jaw members of a clip applier aspresently disclosed such that each leg is retained within the undercutportion of each groove. The jaw members are then closed such that theretained legs of the clip are compressed together and the width anddiameter of the clip is minimized. The clip applier is then inserted andpositioned within the patient such that the closed jaw members areplaced adjacent the vessel or other tissue to be clipped. The jawmembers along with the retained clip, are then opened. The open jawmembers are manipulated or positioned within the patient such that thelegs of the retained clip extend over the tissue. The jaw members arethen closed such that the legs of the clip are compressed over thevessel or other tissue. The clip applier is then removed from thepatient.

In another broad aspect of the present invention, the method includesthe step of applying a distal or forward force on the clip while withinthe jaw members such that the distal portions of each leg are forcedinto the undercut portions of each jaw member. This step retains theclip within the jaw members.

In yet another broad aspect of the invention, the surgical clip isremoved from within the jaw members by relieving the distal or forwardforce on the proximal end of the clip. The jaw members are then slightlyopened to relieve any compressive pressure on the clips by the closedjaw members. This action allows the clip to move freely within thegrooves. The clip applier is then moved distally or forward relative tothe clip such that the distal portions of the legs are withdrawn fromwithin the undercut portions of each jaw member. The jaw members arethen opened such that the clip is left compressed on the tissue. Theclip applier is then removed from the patient.

The invention, together with the additional features and advantagesthereof, which was only summarized in the foregoing passages, willbecome more apparent to those of skill in the art upon reading thedescription of the preferred embodiments, which follows in thespecification, taken together with the following drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side elevational view of an embodiment of an endoscopic clipapplier according to the principles of the present invention, theapplier shown adjacent a vessel to be occluded;

FIG. 2 is a sectional view of the clip applier as depicted in FIG. 1,taken along lines 2—2;

FIG. 3 illustrates the clip applier as depicted in FIG. 2 shown in theclosed position;

FIG. 4 illustrates the clip applier as shown in FIGS. 2 and 3, rotated90 degrees;

FIG. 5 is a cross-sectional view of the clip applier as depicted in FIG.4 taken along lines 5—5;

FIG. 6a is a top view of a jaw member as depicted in FIG. 1;

FIG. 6b is a side view of a jaw member as depicted in FIG. 1;

FIG. 6c is a view of the interior of a jaw member as depicted in FIG. 1;

FIG. 7 is a side elevational view of an embodiment of a clip applier ofthe present invention, shown having an alternative actuating mechanism;

FIG. 8a is a sectional view of the clip applier as depicted in FIG. 1,shown having a retracted push member;

FIG. 8b illustrates the clip applier as depicted in FIG. 2, shown withthe push member withdrawn and the jaw members partially opened; and

FIG. 8c illustrates the clip applier as depicted in FIG. 8b, shown withthe jaws partially opened and the clip applier withdrawn.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring now to the drawings, wherein like reference charactersdesignate identical or corresponding parts throughout the several views,an endoscopic clip applier of the present invention is illustrated inFIG. 1 and generally indicated by reference numeral 10.

As shown, the clip applier 10 of the present invention includes anelongated outer body 12 having a proximal end 14 connected to anactuating mechanism 16 and a distal end 18 coupled to an operatingassembly 20. A longitudinal axis 22 is generally defined along theelongated body 12. A surgical clip 24 is insertable within the operatingassembly 20 for occluding a vessel 26 or for ligating other tissue.

The elongated body 12 which may be an elongated rigid shaft havingdistal end 18 and proximal end 14 and an axial passage 22 therebetween.The elongated body 12 may be made from a variety of rigid biocompatiblematerials including a metal such as stainless steel, a plastic such asacrylonitrile-butadiene-styrene (ABS), a polycarbonate material or thelike. In a preferred embodiment, the elongated body 12 is rigid, howeverit may also be made from a compliant material to allow some flexibilityin the shaft.

In a preferred embodiment, the elongated body 12 may comprise arelatively narrow outer diameter facilitating insertion into and througha trocar, a cannula or a small incision. The tubular structure 12preferably includes a wall having sufficient thickness to structurallysupport the operating assembly 20, its operation and any requiredmanipulation within a patient. Preferably, the elongated body 12 has arounded cross-section which may be circular or oval, for example.

The proximal end 14 of the elongated body 12 is preferably rigidlysecured to the actuating mechanism 16 such that the endoscopic clipapplier 10 is a generally structurally rigid device. Thus, the proximalend may be attached to the actuating mechanism 16 using any of the widevariety of methods available and known to those of skill in the art ofmanufacturing surgical devices. As an example, the proximal end 14 maybe attached to the actuating mechanism 16 through welding, the use ofadhesives, fasteners, or a threaded fitting.

The distal end 18 of the elongated body 12 is coupled to the operatingassembly 20 to provide structural support as well to allow the operatingassembly 20 to be moved between an open position and a closed position.In a preferred embodiment, the elongated body 12, which may be a hollowtubular member, is not directly attached to the operating assembly 20but is operatively moved relative to a tapered or cammed outer surface28 on opposing sides of the operating assembly 20. This movement overthe cam surfaces 28 moves the operating assembly 20 between an openposition and a closed position.

Referring now to FIGS. 2-5, the endoscopic clip applier 10, and morespecifically the operating assembly 20, will be described in greaterdetail. The operating assembly 20 includes a pair of generally opposingjaw members 30. Each of the jaw members 30 extends outwardly from apivot point 32 adjacent the distal end 18 of the elongated body 12.

Alternatively, each of the jaw members 30 may extend from a separatepivot point. Another configuration contemplates one of the jaw members30 being fixed with the other pivotable. A first biasing spring 34 ascan be see in FIG. 2, may be inserted between the jaw members 30 toretain the jaw members in a normally closed position. However, the jawmembers 30 may be maintained in normally closed position through use ofother methods as are commonly to known to those of skill in the art ofsimilar devices. Alternatively, the biasing spring 34 may be used tomaintain the jaw members 30 in the open position as shown in FIG. 2. Inyet another configuration, the operating assembly 20 may be providedwithout any biasing spring or other mechanism.

In the illustrated embodiment, a groove 36 extends longitudinally alongan inner surface 38 of each jaw member 30. Preferably, each groove 36extends distally from a proximal point on the inner surface 38, andterminates in an undercut portion 40. This undercut portion 40 which mayalso be a bore, or an overhang portion, is configured for releasablyretaining the distal end of a clip leg 42 as will be further described.In addition, each jaw member 30 preferably extends distally beyond theundercut portion 40 such that the clip 20 is fully retained within thejaw members 30. Thus, the clip 20 is fully retained within the jawmembers 30 when the operative assembly 20 is in the closed position.Alternatively, when the operating assembly 20 is in the open position,the clip 20 is maintained within the grooves 36 such that a smooth andgenerally flush surface is provided along the inner surface 38 of eachjaw member 30. In this way, a surgeon may manipulate the clip applier 10within a patient with the jaw members 30 open, without fear of catching,tearing or otherwise damaging tissue because of a protruding clip orother non-smooth surface.

Referring now to FIGS. 6a- 6 c, an embodiment of the jaw members 30according to the present invention will generally be described. Each jawmember 30 includes a pivot clevis 44 at a proximal end and includes abore 45 for receiving a pivoting axis or shaft. In a preferredembodiment, each jaw 30 generally tapers downwardly to a smooth roundedfront distal end 46. This configuration is preferably minimized in widthor diameter so it may be passed through a cannula, trocar or even asmall incision in the patient.

Each jaw member 30 includes a groove 36 having a smooth proximal portion48 and an undercut portion 40 as previously described. The smoothproximal portion 48 is preferably configured such that the surgical clip24 may fit smoothly and flush within the groove 26. Alternatively, thesmooth proximal portion 48 may be configured such that the surgical clip24 is properly supported during compression allowing proper closure orclipping against the vessel to be occluded or other tissue. As can beseen in FIG. 6b, the undercut portion 40 may be an inward taper andpreferably defines an angle of approximately 30 to 60 degrees from theinner surface 38 or longitudinal axis 22 when in the closed position.However, other angles as well as other undercut configurations may beused.

The main object of the undercut portion 40 is to releasably retain thesurgical clip 24 inserted within the grooves 36, and more particularly,whose distal ends 42 are pushed inwardly against the undercut portion40. The undercut portion 40 is also designed such that the clip 20 iseasily released from the grooves 36 when the surgical clip 24 is movedproximally or rearwardly within the grooves. This movement frees thedistal ends 42 from the undercut portions 40 and allows the jaw members30 to be pivoted away leaving the clip 20 behind.

As previously mentioned, the distal ends 46 of each jaw member 30 extenddistally beyond the undercut portion 40. The inner surface 38 of eachjaw member 30 adjacent the clip 20 is typically flat such that theopposing jaw members 30 lay fully closed along the longitudinal axis 22.A tapered or angled surface leading distally from the pivot clevis 44 isprovided along the outer proximal portion of each jaw member 30 to acammed outer surface 28. In a preferred embodiment, each jaw member 30is generally symmetrical with the exception of the pivot clevis 44 whichare moved laterally to insure proper alignment with pivot point 32.However, jaw members 30 may be provided which are identical but do notpivot from a common point or alternatively, jaw members 30 may beprovided which are asymmetrical. In another embodiment, one jaw member30 is generally fixed while the remaining jaw member 30 pivots.

Referring now back to FIGS. 2-5, an elongated inner member 50 isprovided to facilitate actuation of the operating assembly 20. Theelongated inner member 50 preferably includes a proximal end 52 which isattached to the actuating mechanism 16 and a distal end 54 which iscoupled to the jaw members 30 through pivot point 32. The elongatedinner member 50 is preferably a shaft, sleeve or a tubular membersimilar to the elongated outer body 12 but of a smaller maximum diametersuch that it is slidable within the elongated outer body 12 by actuationof the actuating mechanism 16.

As can be seen in FIGS. 4-5, the distal end 54 may comprise twoextending members or clevis support tabs. Preferably, these distal ends54 are configured so that each one fits between the pivot devises 44extending from each jaw member 30. A pivot axis 56, or preferably a pairof pivot axes 56, may then be provided to retain each jaw member 30 toeach of the distal ends 54 as shown in FIGS. 4 and 5.

A push member 58 may be provided within the elongated inner member 50 toprovide a distal or forwardly applied force on the surgical clip 24. Inthis way, the push member 58 is moved distally within the elongatedinner member 50 and contacts the proximal portion of the clip 24 forcingthe clip 24 to move distally within the grooves 36 such that the distalend of each clip leg 42 is forced within the undercut portion 40 of eachgroove 36. By maintaining the distal or forwardly force on the pushmember 58, the surgical clip is held retained within the jaw members 30.

A biasing spring 60 may be provided to maintain a continuous forward ordistal force on the push member 58 such that the surgical clip 24 isheld retained within the jaw members 30. However, alternative methods ofmaintaining a distal or forwardly force against the surgical clip 24 maybe utilized. For example, pneumatic pressure directed against thesurgical clip 24, magnetic attraction of the clip into the undercutportion 40 or any other method of maintaining the surgical clip 24within the undercut portion 40 as is contemplatable by those of skill inthe art.

Referring now back to FIGS. 1-3, the actuating mechanism 16 may includeany device which moves the inner member 50 relative to the outer body12. As shown in FIG. 1, the actuating mechanism 16 may include a mainbody 62 which is connected to the outer body 12 as previously. Anactuating handle 64 may be movably coupled to the main body 62 of theelongated inner member 50. In this fashion, when the handle 64 is movedrelative to the main body 62, the elongated inner member 50 is movedwithin and relative to the elongated outer body 12. More specifically,when the handle 64 is moved rearwardly or pulled outwardly from the mainbody 62, the elongated inner member 50 is retracted inwardly orproximally from the elongated outer body 12. This action draws the jawmembers 30 within the distal end 18 of the elongated outer body 12.

As the jaw members 30 are drawn proximally into the generally open andhollow elongated outer body 12, the distal end 18 contacts and slidesagainst the tapered or cammed outer surface 28 of each jaw member 30. Asthis tapered cammed outer surface 28 continues to be drawn inwardly intothe distal end 18 of the elongated outer body 12, the jaw members 30 areforcibly closed as shown in FIG. 3.

Conversely, moving the handle 64 distally or forwardly into the mainbody 62 pushes the elongated inner member 50 relative the elongatedouter body 12 and forces the jaw members 30 outwardly or distally fromthe distal end 18. As the jaw members 30 are moved distally out of theelongated outer body 12, the first biasing spring 34 forces the jawmembers 30 into the open position. Alternatively, the first biasingspring 34 may be coupled with the actuating handle 64 for forcing thehandle in one direction with respect to the main body 62 such that thejaw members 30 are normally maintained in either the opened or closedposition. Alternatively, the first biasing spring 34 may be supplied intwo configurations, the first for maintaining the handle 64 outwardlyfrom the main body 62 such that it must be pushed by the surgeon toactuate the operating assembly 20 or alternatively where the handle 64is maintained adjacent the main body 62 such that the surgeon must pullto actuate the operating assembly.

A second actuating handle 66 may be movably coupled to the main body 62for actuation of the push member 58. The push member 58 may preferablybe a shaft or rod extending from the second actuating handle 66 slidablythrough the elongated inner member 50 and between pivot axes 56, asshown in FIGS. 4 and 5, to contact the surgical clip 24. The biasingspring 60 may be then coupled anywhere within the elongated inner member50 but is preferably coupled to the second actuating handle 66 such thatthe push member 58 is normally held against the surgical clip 24 andthus requires physical action by the surgeon to retract the push member58 removing the force against the clip 24.

Referring now to FIG. 7, an alternative actuating mechanism 68 is shown.In this configuration, the main body 70 is similar to that previouslydescribed. However, the actuating handle 62 may be styled as a handgrip. A biasing spring (not known) may be used to maintain the actuatinghandle 62 in the outward position such that the surgeon must compress itto either close or open the operating assembly 20. Preferably, movementof the actuating handle 62 opens or closes the operating assembly 20without effect on the push member 58 which is maintained forciblyagainst the clip 24. In this configuration, the surgeon or otheroperator must actively remove or otherwise retract the push member 58from against the clip 24.

In yet another configuration, the elongated inner member 50 may befixedly attached to the main body 70 and the elongated outer body 12movably attached to the actuating handle 62. In this fashion, movementof the actuating handle 62 may provide a closing and opening effect on amodified operating assembly. In this configuration, a single fixed jawand a pivoting jaw may be preferred. However, alternative mechanisms maybe included within the main body to achieve differing actions andcompressive strengths on the jaw members 30. Alternatively, othermethods may be used to open and close the jaw assemblies as well as foractuating mechanisms as is commonly known or contemplated to those ofskill in the art.

The surgical clip 24 is preferably a U-shaped or V-shaped surgical clipwhich has a pair of generally opposed legs 42. An intermediate portion74 interconnects the respective legs 42. This U-shaped clip 24 is meantto include V or other similarly shaped clips. Preferably, the clip 24 ismade from a malleable material which allows it to be compressed orclosed within the jaw members 30 and then reopened several times. Thus,the material may include any biocompatible material which is flexibleyet maintains sufficient strength such that it may occlude or otherwiseclip tissue. Such a clip 24 may be made from titanium, alloys oftitanium, or a stainless steel.

As previously described, the distal end of each clip leg 42 preferablyterminates in an outward taper 76 or similar such that it is retainablewithin the undercut portion 40 within each jaw member 30. Preferably,this outward taper defines an angle of approximately 30 to 60 degreesfrom the clip leg 42 and preferably matches the angle of the undercutportion 40.

The clip legs 42 preferably have a cross-sectional size or area thatfits within each groove 36 such that the inner surface 38 of each jawmember 30 is a smooth continuous surface even with the clip 24 inserted.It is an important feature of the present invention that the clip 24fits within the grooves 36 and that the distal ends of the legs 42 areslidable such that they are retained within the undercut portions 40,regardless of the clips 24 shape or cross-section and regardless of theshape of the undercut portion 40.

Referring now to FIGS. 2, 3, and 8 a- 8 c, a method of using anendoscopic clip applier 10 of the present invention in an endoscopicsurgical procedure (which includes laparoscopic as well as arthroscopicprocedures for purposes of this disclosure) will be described. Initiallya malleable clip is loaded or otherwise inserted between jaw members 30by inserting the clip legs 42 into the grooves 36. The push member 58may be then used to slidably force the clip 24 forwardly or distallywithin the grooves 36 such that the outward taper 76 on the distal endof each clip leg 42 is moved within the undercut portion 40 of eachgroove 36. The jaw members 30 are then closed such that retained legs 42of the clip 24 are compressed together. In this configuration, thediameter or overall cross-sectional area of the endoscopic clip applier10 is minimized. This allows insertion into a cannula (not shown) ofminimal diameter while supplying a surgical clip 24 of almost any size.

The clip applier 10 is then manipulated within the patient such that theclosed jaw members 30 are moved adjacent to a vessel or tissue to beclipped. The jaw members 30 are then opened using the actuatingmechanism 16 and the clip applier 10 moved forwardly or otherwisemanipulated within the patient such that the clip 24 extends over andgenerally surrounds the vessel or tissue. The actuating mechanism canthen be actuated again such that the jaw members 30 are closed and theclip legs 42 compressed over the vessel and tissue, thus occluding orclipping the tissue.

The actuating mechanism 16 may again be actuated to pivot the jawmembers 30 for relieving any compressive pressure on the clip 24 by theclosed jaw members 30. This allows the clip 24 to now slide freelywithin the grooves 36. The push member 58 is then retracted or otherwisemoved proximally such that the forward or distal force against the clipis removed. The clip applier 10 is then moved or manipulated within thepatient such that the clip 24 is moved proximally within the groove 36.This movement, removes or withdraws the outward taper 76 on each clipleg 42 out from the undercut portion 40 of each groove 36 as shown inFIG. 7a. The actuating mechanism may then be moved such that the, jawmembers 30 are opened, leaving the clip 24 remaining compressed againstthe vessel or other tissue.

The jaw members 30 may be partially opened as shown in FIG. 86 justsufficiently to allow retraction of the endoscopic clip applier 10 fromover the vessel or other tissue and applied clip. In this fashion, anyadditional damage to surrounding tissue by the opened jaw member 30 canbe minimized. Once the clip applier 10 has been retracted proximally ofthe applied clip 24, the jaw members 30 may again be closed to minimizethe diameter or otherwise cross-sectional area of the clip applier 10.The clip applier 10 may then be removed from the patient.

A major advantage of the present invention is that it allows for therepositioning of a clip 24 in the event it was improperly applied. Inaddition, the clip applier 10 of the present invention allows for therepositioning of a previously applied clip 24 as well as for clip 24removal. These procedures, follow the procedure previously discussed forapplying a clip 24, but in a slightly different order.

To engage a clip 24, the clip applier 10 is generally inserted through acannula or other opening into a patient while the operating assembly 20is maintained in the minimized or closed position. The clip applier 10is then positioned adjacent the clip 24 to be repositioned or removed.The jaw members 30 are then pivoted open sufficiently to be moved aroundthe clip 24. Once the jaw members 30 surround the clip 24, the jaws maybe pivoted closed such that they capture the clip 24. Some manipulationmay be required to insure that the clip fits into the grooves 36,however the surgeon will know when the clip 24 is captured since the jawmembers 30 will fully close. The push member 58 is then extended ormoved distally such that a forward or distally applied force is placedon the clip 24, moving the clip 24 distally within the grooves 36 andforcing the outward taper 76 on the clip legs 42 within the undercutportion 40 of each groove 36. The clip applier 10 and the retained clip24 may then be removed as previously described for the clip applier 10.

It will be understood that various modifications can be made to thevarious embodiments of the present invention herein disclosed withoutdeparting from the spirit and scope thereof. For example, various sizesof the clip applier and clip are contemplated as well as various typesof construction materials. Also, various modifications may be made inthe configuration of the parts and their interaction. Therefore, theabove description should not be construed as limiting the invention, butmerely as an exemplification of preferred embodiments thereof. Thoseskilled in the art will envision other modifications within the scopeand spirit of the present invention as defined by the claims appendedhereto.

What is claimed is:
 1. An endoscopic clip applier, comprising: anelongated body having a proximal end and a distal end, and defining alongitudinal axis; an operating assembly coupled to the distal end, saidassembly including a pair of pivotally opposing jaw members extendingoutwardly from the elongated body, each jaw member having a grooveextending longitudinally along an inner surface and terminating at anoverhang which defines with the groove an undercut space for releasablyretaining the surgical clip within the jaw members; a surgical cliphaving legs with distal ends retained by the overhang in the undercutspace of the jaw members; and an actuating mechanism attached to theproximal end of said elongated body of actuating the pivotally coupledjaw members and retained clip legs between an open position and a closedposition.
 2. An endoscopic clip applier as recited in claim 1 whereineach of the jaw members has an inner surface and said inner surfacescontact each other along the longitudinal axis when the jaw members areclosed.
 3. The endoscopic clip applier as recited in claim 1 wherein theclip is made from a malleable material.
 4. The endoscopic clip applieras recited in claim 3 wherein said clip has a generally U-shapedconfiguration with a pair of generally opposed legs connected by anintermediate portion.
 5. An endoscopic clip applier as recited in claim4 wherein each of said grooves is sufficiently long and sufficientlydeep that a substantial portion of the associated leg of the clip isretained flush relative to said inner surface of the associated jaw. 6.The endoscopic clip applier as recited in claim
 4. wherein: each of thelegs extends to a distal end; and the distal end of each leg isconfigured to fit within the space portion of the associated jaw member.7. The endoscopic clip applier as recited in claim 6 wherein eachoverhang defines an inwardly tapering portion of each groove.
 8. Theendoscopic clip applier as recited in claim 7 wherein each leg of theclip terminates in an outward taper which mates with the inwardlytapered portion of each jaw member when the clip is moved distallywithin the grooves.
 9. An endoscopic clip applier for applying asurgical clip having legs with distal ends, to a vessel or other tissue,said applier comprising: a hollow elongated outer body having a proximalend connected to an actuating mechanism and a distal end; an actuatingmechanism coupled to the proximal end of the outer body; an elongatedinner member having a proximal end and a distal end, the proximal endbeing attached to the actuating mechanism, said inner member extendingoutwardly through the elongated outer body and being slidable within theouter body by operation of the actuating mechanism; an operatingassembly coupled to the distal end of the inner member said assemblyincluding a pair of pivotally opposing jaw members, each jaw memberhaving portions defining a groove extending along an inner surface, andan overhang defining with the groove portions an undercut space; and apush member coupled to said actuating mechanism for applying a forceagainst the clip such that the clip is moved distally within the groovesand the distal portion of each leg is forced into the undercut space ofthe associated jaw member.
 10. The endoscopic clip applier as recited inclaim 9 wherein said actuating mechanism comprises: a main bodyconnected to the proximal end of the outer body; and an actuating handlecoupled to the main body and connected to the proximal end of the innermember such that movement of the handle in relation to the main bodyforces the jaw members to pivot relative to each other between an openposition and a closed position.
 11. The endoscopic clip applier asrecited in claim 10 and further comprising a biasing spring for forcingthe handle in one direction with respect to said main body such that thejaw members are normally maintained in the open position.
 12. Theendoscopic clip applier as recited in claim 10 wherein said actuatingmechanism further comprises a stationary handle having a fixedrelationship to the main body.
 13. The endoscopic clip applier asrecited in claim 10 wherein the push member comprises a shaft having aproximal end coupled to the actuating mechanism, the shaft extendingslidably through said inner member into a contacting relationship withthe clip.
 14. The endoscopic clip applier as recited in claim 13 whereinthe actuating mechanism comprises a biasing spring for maintaining saidpush member against the clip.
 15. A method of applying a surgical clipto a vessel or other tissue in a patient using a clip applier having anelongated body with a proximal end attached to an actuating mechanismand a distal end coupled to a pair of pivotally opposing jaw members,each jaw member having a longitudinally extending groove terminating atan overhang which defines with the groove an undercut space forreleasably retaining the surgical clip, said method comprising the stepsof: providing a malleable surgical clip having a pair of outwardlyextending legs; placing the malleable surgical clip within the jawmembers such that each leg of the clip is retained in the undercut spaceof the associated groove; closing the jaw members such that the retainedlegs of the clip are compressed together; positioning the clip applierwithin the patient such that the closed jaw members are adjacent thetissue to be clipped; opening the jaw members to force the retained legsof the clip to an open state; positioning the jaw members and the legsof the retained clip over the tissue closing the jaw members to forcethe legs of the clip to a closed state over the tissue, and removing theclip applier from the patient.
 16. The method of applying a surgicalclip as recited in claim 15 and further comprising the step of insertingthe clip applier through a surgical incision in the patient.
 17. Themethod of applying a surgical clip as recited in claim 15 wherein thestep of opening the jaw members and the step of closing the jaw memberseach comprises the step of actuating the actuating mechanism such thatat least one jaw member is pivoted relative to the other jaw member. 18.The method of applying a surgical clip as recited in claim 15, furthercomprising the step of applying a distal force to the clip to move thedistal portions of each leg into the undercut space of the associatedjaw member.
 19. The method of applying a surgical clip as recited inclaim 18 wherein the step of removing the clip applier comprises thestep of: relieving the distal force on the clip; and pivoting the jawmembers to relieve any compressive pressure on the clip; withdrawing thelegs of the clip from the undercut space of the associated jaw members;opening the jaw members such that the clip is left with the tissue; andremoving the clip applier from the patient.
 20. The method of applying asurgical clip as recited in claim 15 and further comprising the stepsof: reinserting the clip applier into the patient such that the jawmembers are positioned adjacent the clip applied to the tissue; openingthe jaw members; positioning the jaw members over the legs of the clip;closing the jaw members such that the jaw members surround the clip andthe legs are moved into the undercut space of the associated jaw member;opening the jaw members to remove the retained clip from the tissue; andremoving the clip applier with the retained clip from the patient. 21.The method of applying a surgical clip as recited in claim 20, whereinthe step of removing the clip applier comprises the steps of: moving theclip applier proximally away from the tissue; closing the jaw members toclose the retained clip; and withdrawing the clip applier and the closedretained clip from the patient.
 22. A method for repositioning asurgical clip having a pair of outwardly extending legs previouslycompressed over a vessel or other tissue in a patient, using a clipapplier including an elongated body having a proximal end connected toan actuating mechanism and a distal end coupled to a pair of pivotallyopposing jaw members, each jaw having a longitudinally extending grooveterminating at an overhang which defines with the groove an undercutspace, said method comprising the steps of: positioning the jaw memberswithin the patient with the jaw members in an open state and disposedrelative to the surgical clip; closing the jaw members to engage theclip with the legs of the clip retained in the grooves; moving the cliplongitudinally within the grooves of the jaw members to force the legsof the clip into the undercut spaces of the jaw members; opening the jawmembers to force the retained clip to an opened state; moving the clipapplier within the patient to reposition the jaw members relative to thevessel; closing the jaw members to force the retained clip to a closedstate on the vessel; and removing the clip applier from the patient. 23.The method of repositioning a surgical clip as recited in claim 21wherein the step of moving the clip comprises forcing the clip distallywithin the grooves.